Pet Pharmarcy

Overview

Diabetes mellitus is a disorder of carbohydrate, protein and fat metabolism caused by either an absence of insulin or an inability of the body to use insulin. The result is a high blood sugar level, weight loss, increased urination and drinking and may lead to death if untreated.

Pathogenesis

Insulin is produced in the pancreas by Beta cells. Some animals, like humans, can be born diabetic, while others can develop it through viral diseases, immune-mediated destruction of the Beta cells, overproduction of steroids (as seen in Cushing's disease) or animals given steroids orally or by injection for lengths of time (especially in cats). This type of diabetes is known as insulin dependent diabetes. In other animals obesity can lead to a condition called peripheral insulin resistance or non–insulin-dependent diabetes – where the pancreas is working, but either dies not release sufficient insulin or the body does not adequately respond to it.

Insulin helps glucose enter the body's cells. The glucose is used by the cells for energy. When glucose cannot enter the cells, the body must find other sources of energy – it turns to fat. The liver converts fat into ketones, which the body burns, but this is not sustainable and can lead to liver failure and death.

Early clinical signs include drinking and urinating large amounts of water, sudden weight loss, increased appetite and muscle wasting. Obesity with sudden recent weight-loss is a typical finding, especially in cats. Later signs can include lethargy, poor haircoat, cataracts in dogs, anorexia, vomiting, yellowing of the gums and skin.

The most commonly affected dog breeds include Cairn terriers, miniature pinschers, dachshunds, keeshonds, poodles and beagles. There is no breed prediliction in cats, but obese cats are far more likely to have become diabetic.

Treatment Options

Dietary management is important. Talk with your veterinarian about foods that are specially formulated to control blood sugar. Diet is an essential component of diabetes management. Overweight animals will need to be put on a diet that slowly reduces their weight.

In most cases, insulin must be given to the animal by injection twice per day. The animal must be carefully monitored by your veterinarian to ensure that the blood sugar levels do not drop too quickly. Low blood sugar can result in coma and death.

Some cats can be treated successfully with glipizide, a medication that helps regulate blood sugar levels.

How Center Pet Can Help

Center Pet caries all brands of insulin, including Vetsulin®, glargine and others. The pharmacy also stocks insulin syringes and sharps containers and blood glucose monitors specifically made for pets. The pharmacists can also make glipizide for cats. It is our goal to make treating your diabetic animal as easy as possible by having all the medications and supplies needed under one roof.

Overview

Hyperthyroidism is the result of high levels of thyroid hormone in the bloodstream. It results in weight loss, cardiac disease, kidney damage, high blood pressure and other problems. It is most commonly found in middle-aged to older cats.

Pathogenesis

The condition in cats is most commonly caused by autonomously hyperfunctioning nodules on the thyroid gland. In nearly all cases in cats, it is non-cancerous. Elevated thyroid hormone levels can cause weight loss (most common), cardiac problems including murmurs, kidney damage, poor haircoat, aggression or increased attention-seeking behavior and in some cases, depression, anorexia and vomiting.

Hyperthyroidism in dogs is usually caused by over-supplementation with thyroid hormone or from a thyroid carcinoma.

Treatment Options

There are three methods for treating hyperthroidism in cats. Surgery can be performed, but this is no longer common. Administration of radioactive iodine, which targets the thyroid and destroys most of the affected tissue, has gained popularity in recent years. It should not be performed until after a thorough work-up, including medically lowering thyroid levels to normal to ensure that the kidneys are working properly.

Methimazole (Tapazole®) is a medication that limits the production of thyroid hormone in the thyroid gland. It is used successfully in many cats. The medication is generally given twice a day by mouth, but can be used as a transdermal gel. The most common side-effects include anorexia, vomiting and less commonly, blood cell abnormalities. Rarely it makes cats scratch themselves and can cause liver abnormalities.

How Center Pet Can Help

Center Pet has methimazole in stock at all times. The pharmacists can make methimazole into an easy to administer liquid, chewtab or transdermal gel. It is a bitter medication in tablet form, but can be made into a palatable liquid and chewtab. Hyperthyroidism can be managed for a number of years with successful medicating.

Overview

Incontinence is simply the loss of voluntary control of urination. It can be seen as dripping urine while walking or leaving a urine stain on the bed while sleeping. It can lead to urinary infections and skin infections if the urine stays in contact with the skin.

Pathogenesis

There are a number of causes of incontinence – ranging from anatomic abnormalities, to neurologic causes, bladder storage dysfunction, overflow, to age in females. It is important to understand the cause of the incontinence in order to try and solve the problem.

Structural anatomic abnormalities include congenital bladder hypoplasia (born with a small urinary bladder), ectopic ureters (the tubes connecting the kidneys to the bladder do not enter the bladder at the correct spot), urethral hyposplasia (small urethra – leads from bladder to the outside) and several other less common causes.

Neurologic lesions can lead to incontinence. Spinal trauma, including congenital malformations and intervertebral disc disease and fractures, can cause the bladder muscles to not contract, leading to a very full bladder and the urine then leaks out. This is known as overflow incontinence – similar to an overflowing bathtub. Brain injury can also lead to incontinence through other mechanisms.

The most common cause seen in veterinary medicine is urinary sphincter incompetence, usually caused by a hormone imbalance, urinary tract infection or prostate disease. Spayed middle-aged, medium to large-breed female dogs are most likely to be incontinent.

Some dogs with metabolic diseases will show incontinence-like signs. This may be seen with diabetes and Cushing's disease, among others.

Treatment Options

If there is an infection present, proper treatment with antibiotics may restore urinary continence. Your veterinarian will assess the urine and possibly blood chemistries to try to ascertain the cause of the incontinence.

In uncomplicated sphincter incompetence cases, phenylpropanolamine (PPA) may be used. This medication, available as Proin® and other brands as well, tightens the urinary sphincter muscles, restoring continence. In some female dogs, this may not work, but hormone replacement with diethylstilbesterol (DES) may be the solution.

Surgical options now also exist for sphincter incompetence and include injection collagen in the urethra near the bladder wall. For structural abnormalities, surgery may be indicated.

How Center Pet Can Help

Center Pet carries nearly every antibiotic used to treat bladder and urinary tract infections. The pharmacy also stocks Proin® and other phenylpropanolamine products. The pharmacists can make PPA into a liquid or chewtab preparation, if needed. DES is also carried by the pharmacy and like PPA, can be made into a capsule, liquid and chewtab.

Overview

Addison's disease, also known as hypoadrenocorticism, is an endocrine disorder that results from the deficient production of certain steroids by the adrenal glands. The condition may result in diarrhea, lethargy, vomiting, weight loss, increased urination and drinking, along with decreased appetite, decreased heart rate, weakness, dehydration and death. If untreated Addison's disease can be fatal. It is most commonly seen in middle-aged, spayed, female dogs.

Pathogenesis

The adrenal glands, located near the kidneys, produce several steroids (mineralocorticoids and glucocorticoids) that are responsible for normal metabolic function. Mineralocorticoids (aldosterol) function to help the body eliminate potassium and retain sodium. High potassium levels can result in damage to the heart and can even cause it to beat irregularly, sometimes leading to fatal arrhythmias. Low sodium results in low blood pressure and blood volume leading to hypotension, depression, weakness and azotemia. Glucorticoid (cortisol) deficiency leads to vomiting, depression, bloody diarrhea, low blood sugar and other problems.

Addison's disease usually has no discernible cause. It can also be caused by an overdose of mitotane (used to treat Cushing's disease). Tumors of the adrenal glands or adjacent tissues have been shown to contribute to Addison's disease. Sudden withdrawl of long-term steroids can also lead to Addison's disease.

Treatment

An acute Addisonian crisis requires immediate medical attention, including fluids and hospitalization. Once stable lifelong glucocorticoid and/or mineralocorticoid replacement treatment is needed. The mineralocorticoid most commonly used is DOCP, under the trade name Percorten-V®. It is used once every 21-28 days as an injection. Prednisone is used as the glucocorticoid and is usually given once daily. Routine monitoring is used by veterinarians to ensure proper treatment.

How Center Pet Can Help You and Your Pet

Center Pet has DOCP in stock as Percorten-V®, along with syringes used to administer the medication. The pharmacy also has prednisone and can provide it in tablet, chewtab and liquid form. Please do not hesitate to call or write if you have any medication questions.

Overview

Feline asthma (also known as allergic bronchitis, allergic airway disease, feline bronchial disease) is a condition similar to asthma in humans. It is found in about 1% of all cats, but may be increasing in occurrence. An asthma attack appears as if the cat is trying to cough up a hairball, but there is no hairball present. The condition can be life-threatening and worsens with time, especially if not treated. Treatment options are usually quite successful.

Pathogenesis

Spasms occur in the bronchi in the lungs, causing inflammation and swelling. This restricts airflow resulting in difficult breathing. The inflammation is usually caused by environmental allergens or stresses such as pollen, house and dust mites, dust, mildew, smoke, cold and dry air, and possible stress and food allergies.

Treatment Options

The first step is seeking veterinary care for your cat. After the cat has been stabilized and placed on an appropriate medication, return home and see what allergens are present. You may not see them, but they are there. Place your cat in a room and close the door. Vacuum the entire house as well as possible to eliminate as much dust as you can. Having an air filter (not an ionic air filter) can help with long-term management. Take out all rugs and beat them clean. Be sure the cat littler is dust-free.

Feline asthma can be treated via oral medications (bronchodilators and / or steroids) or with inhaled medications, the most common being fluticasone (Flovent®). Treatment is usually life-long. For the inhalers, which have been shown to be the most effective treatment for most cats, you will need an AeroKat® spacer to place over the cat's muzzle in order to administer the medication.

How Center Pet Can Help You and Your Vet

Center Pet carries all of the medications used to treat feline asthma. We can make all of the oral medications into a liquid, chewtab and in most cases, a transdermal gel as well. The pharmacy also has Flovent® and AeroKat® inhalers in stock at all times.

Overview

Constipation is the infrequent, incomplete, or difficult defecation with passage of hard or dry stool. There is usually an underlying cause.

Pathogenesis

Constipation can occur with any disease that impairs the passage of feces through the colon. It can be caused by dietary factors including ingesting bones, hair, too much fibers and foreign materials. A number of medications cause slow emptying of the colon, including many pain medications, some antacids, diuretics, antihistamines and others. Mechanical problems, including prostate disease, narrow pelvic canal secondary to an improperly healed fracture, tumors in the colon or in the tissues or bones near the colon, rectal strictures, perineal hernias, rectal diverticulum, rectal prolapse and congenital defects. Chronic constipation issues can also be caused by neuromuscular disease – paralysis, spinal cord disease, intervertebral disc disease, sacral nerve trauma or colonic smooth muscle dysfunction as seen in idiopathic megacolon in cats.

Anything that causes or contributes to dehydration can lead to constipation. It is frequently seen in animals with renal failure and in hyperthyroid cats.

Treatment Options

The main treatment involves fixing the underlying cause of the constipation. But in many cases, the constipation is chronic and must be managed to ensure regularity. Dietary management can be helpful, including a low residue food. In some cases the addition of fiber can be of assistance – canned pumpkin or Metamucil® may be useful. Adding water to food and encouraging drinking are essential. For cats, a flowing water fountain may be helpful. Bouillon cubes in a dog's water make the water more palatable.

Medications are used in may cases as well. Cisapride helps increase intestinal motility and is used with success in cats. Lactulose is a sugar solution that is fermented in the colon, pulling water into the feces making it much softer. Ranitidine has also been used to help move stool along.

In certain cases, surgery is needed for correction of the underlying problem of the constipation.

How Center Pet Can Help You and Your Pet

Center Pet has cisapride, lactulose and ranitidine, along with a host of other medications used for constipation, in stock. We can make cisapride into a capsule, liquid, chewtab and transdermal gel. The pharmacists can also add flavoring to lactulose, making it much more palatable. We can assist your veterinarian in ensuring your pet receives the best medication for the condition at hand.

Center Pet can assist your veterinarian in properly formulating medications to treat Cushing's Disease.

• Overview of Cushing's Disease
• Causes
• Treatment Options
• Center Pet makes treatment easy

Overview of Cushing's Disease

Cushing's disease, otherwise known as hyperadrenocorticism, is the term used for the syndrome when the body is exposed to excessive cortisol, a steroid produced within the adrenal glands. These glands are located deep within the body, near the kidneys. Cortisol is an important hormone necessary for normal function, but in excessive quantities can result in increased drinking and urination, abdominal fat accumulation, hair loss, lethargy, panting, skin disease, urinary infections, difficulty breathing, and other abnormalities. In time this can lead to poor quality and shortening of life.

Causes

Cushing's Disease has three basic causes. The first and easiest to treat, is what we call iatrogenic – in other-words, caused by us through excessive administration of steroid medications. Steroids are given for treatment of certain diseases, but in some cases, the dose can cause Cushing's signs. This can even include some eye drops! The treatment involves slowly reducing the steroid dose. More commonly (85%), it is caused by small tumor on the pituitary gland, located at the base of the brain. The tumor causes the gland to produce excessive ACTH hormone, which tells the adrenal gland to produce cortisol. Most of the time this tumor is benign, but in select cases can cause neurologic signs. The other 15% is caused by a more serious condition in which there is a tumor growing directly on one or both adrenal glands. About ? of adrenal tumors are malignant cancers and can spread.

Treatment Options

The normal treatment for Cushing's Disease caused by a pituitary tumor involves the use of medications to either reduce the ability of the adrenal gland to produce steroids by selectively killing adrenal cells (Lysodren® – otherwise known as mitotane) or Vetory® (trilostane), which works at the level of the adrenal gland to block the normal steroid production pathway. In general Vetory® has a lower incidence of side-effects. Vetoryl® is manufactured by Dechra Pharmaceuticals.

Overtreatment with mitotane can cause a condition known as Addison's Disease – where the adrenal gland is producing too little coritsol and other important hormones necessary for well-being. In a small number of dogs, trilostane can have a similar effect.

In most dogs trilostane is well tolerated. Some mild biochemical abnormalities may be noted on routine bloodwork, but in most cases they usually resolve with time. Your veterinarian will closely monitor the dose of trilostane through routine bloodwork and testing cortisol levels.

Side effects of trilostane can include lethargy, diarrhea, inappetance, weakness and vomiting. If you notice any of these signs, it is important to call your veterinarian as soon as possible.

Trilostane should be used with caution in dogs on certain potassium-sparing diuretics as there is a risk of causing the dog to have an elevate potassium level.

Center Pet

Center Pet stocks Vetoryl® and its generic, trilostane, along with Lysodren®. Currently Vetoryl® comes in 30mg and 60mg capsules, dispensed in thirty dose boxes. Many dogs require doses that differ from these two sizes. Center Pet can make trilostane, the same ingredient as Vetoryl®, into the dose prescribed by your veterinarian. We can make trilostane into capsules, liquid and chewtabs, making medication administration as easy and convenient as possible. We have 16 pet-friendly flavors that do not contain any harmful additives including alcohol and propylene glycol. It is important that your dog's medications be easy to administer, yet as safe as possible. As with Vetoryl®, we can tailor-make Lysodren® to your veterinarian's specifications.

We are here to make medicating pets safe, easy and affordable. If you or your veterinarian have any questions about these medications or Center Pet's compounding of trilostane or Lysodren®, do not hesitate to call one of our pharmacists at 202-464-1911.